Free – A breast cancer survivor story
Posted on 23 September 2019
Anneke Landman was fit, healthy and young – shocked by her sudden cancer diagnosis. Here’s how she beat the disease.
For Anneke Landman, breast cancer began as a nagging thought at the back of her mind. “I’d just turned 37. One morning, just like every other morning, I went to the bathroom. I remember thinking that I’d never self- examined for lumps. So I did, and I felt something. Something really small.”
Along with never having examined herself for breast lumps, she’d also never been for a mammogram. “I called the doctor and booked a test right away. The first time I was examined I was told that it’s very small and didn’t look like it could be cancer. At that point I took a step back – I told myself it wasn’t serious, I’d be fine. I’m a positive person. But when I went for the second check-up, they told me it had grown to 17mm.”
Anneke was booked in for a sonar-guided needle biopsy, to test her breast tissue, after which she was told the lump was a fat necrosis: a harmless piece of dead or damaged breast tissue that sometimes appears after breast surgery, radiation or trauma. “I shifted it out of my mind – but then it started irritating me. I decided to have it removed, and after the surgery to take it out, I went back to my doctor to have the stitches removed.”
Her diagnosis came as a shock. “On the way home in the car, I got the call to say I had breast cancer. I had to pull over. I started laughing, then I started crying. I thought I was bullet-proof. I couldn’t believe I actually had cancer.”
Breast cancer has been identified as a national priority by the Department of Health. About 19.4 million women over the age of 15 are at risk of being diagnosed with the disease, according to National Cancer Registry statistics collected by the Cancer Association of South Africa in 2014.
Understanding your risk, and identifying symptoms early, is key to effective treatment. “There are many different early signs of breast cancer,” says Dr Rika Pienaar, a clinical oncologist at Mediclinic Panorama. “The most common one is a lump in the breast. If you don’t examine your own breasts regularly, you won’t be able to pick up the fact that a lump is growing.”
Other signs include a consistent pain, or a bloody discharge from the nipple. Some symptoms are clear – eczema of the nipple, a persistent redness or an orange peel-like appearance of the skin – while others are more subtle.
“Look closely at your breasts, with your hands on your hips, and again with your hands above your head. If you can see a nipple retraction, a dimple or a change in the shape of the breast – such as a bulging on one side or an increase or decrease in breast size, these are all warning signs you should see a doctor.”
Dr Pienaar, who guided Anneke’s treatment along with other experts in a multidisciplinary team at Cancercare’s Panorama Oncology Centre, says women should begin to self-examine for signs of changes in the breast from as early as 20 years old.
A comprehensive self-exam should involve feeling and looking, she says. “It’s important to realise that breasts are usually quite lumpy in general. So if you examine them regularly, from different angles in the mirror, you get to know your breasts quite well, and you will be more likely to pick up a change early.”
And if you do notice a change or identify a lump? Step one: see a general practitioner, says Dr Pienaar.
“Anneke was 37, which is an age at which it is standard procedure to have a baseline or routine mammogram,” she says. “If you do have symptoms, a doctor will most likely recommend a mammogram, and if you are young, we would suggest you combine that test with a magnetic resonance imaging (MRI) scan.”
Once a lump is identified, Dr Pienaar says a physician will conduct three tests: a clinical examination, or mammogram, followed by an X-ray or ultrasound, and finally, a needle biopsy to con rm the nature of the growth. “For women under 40, breast cancer is a highly uncommon disease,” says Dr Pienaar. “Only 7% of our patients are under 35, and 13% of them are under 40.”
“My first response to hearing about my diagnosis was shock,” Anneke remembers. “I think we all have our own defence mechanisms – and mine was to start giggling. That was my outward reaction. Inside? It’s a weird feeling. The word cancer brings up so much negativity and fear. I stopped the car to call my mom, and that was the hardest part: you’re concerned for yourself, and for the people who love you.”
Whereas doctors used to divide cancers into many different types, depending on what the abnormal cells look like under a microscope, now, experts prefer to categorise cancer according to how it behaves, says Dr Pienaar. “Understanding how and why a specific cancer has developed helps us guide treatment more effectively.”
Today, doctors look at four major molecular subtypes of breast cancer: Luminal A and B, which are tumours featuring receptors that can intercept hormones that occur naturally in a woman’s body, while a third, hormone- receptor negative group, is not stimulated by either oestrogen or progesterone.
Anneke’s case fell into a fourth category: a type of breast cancer in which abnormal cells test positive for human epidermal growth factor receptor 2. Usually, this protein (commonly known as HER2) appears on the outside of all breast cells, attaching oestrogen and progesterone, and using these hormones to help control the ways in which healthy breast cells grow, divide and repair themselves. HER2-enriched breast cancer typically develops faster than the other three types, and can be more difficult to treat. “Until recently,” says Dr Pienaar, “this was a killing disease.”
With Anneke’s lump removed, the target now became her lymph glands. “With cancer there is no standard treatment plan,” says Dr Pienaar. “There are many treatment options, from surgery to radiation therapy, with varying chances of success and a multitude of upsides and downsides, and many factors that go into deciding on the best course of action.”
In Anneke’s case, doctors were faced with the option of surgery to remove the lymph gland, which would hopefully cut the cancer o from the rest of her body. However, they were also mindful of
the fact that the surgery would require extensive X-rays, which in some cases can lead to long-term swelling of the arm. “For someone as active as Anneke, this would compromise her quality of life tremendously,” explains Dr Pienaar.
Dr Pienaar decided on a course of chemotherapy to shrink the affected lymph gland or eliminate the cancer completely. “This type of breast cancer spreads through the bloodstream very quickly,” she says. “Survival depends on the cancerous cells not spreading and creating new tumours elsewhere.”
Anneke was prescribed six months of chemotherapy, followed by surgery. “After all the tests were done and we knew what type of cancer I had and what treatment was needed, I had to make a decision,” she says. “I was a 37-year-old woman who’d never had kids, and I was worried because chemo and other cancer treatments can have very harsh effects on the ovaries and egg production.”
Anneke decided to have her eggs frozen before she began her course of chemotherapy, and was placed in a chemically induced menopause.
“At such a young age, hot flushes, waking up with night sweats … these things were hard to deal with, and not just for me, but for my partner too.”
She was also prescribed doxorubicin, a form of chemotherapy infamous for its toxicity. “Most of the chemotherapy medications have no colour, but this one is bright red,” explains Dr Pienaar. “Patients feel intoxicated, nauseous all the time, their hair falls out, it causes inflammation of the blood vessels and suppresses the immune system, so it can cause secondary infections. It affects our patients very badly.”
How did Anneke get through it? “It might sound odd, but probably the biggest factor was changing my lifestyle,” she says. “Specific changes decreased my toxic load enormously: I stopped drinking alcohol, stayed away from bad foods and listened to what my body wanted. I did a lot of yoga and meditating as well, which is great for my mind and body, walking barefoot in the sand, getting lots of sleep, eating organic foods wherever possible.”
Another factor: expert care. Cancercare uses a multidisciplinary approach to receive each new patient, and it is a method of diagnosis and treatment that is changing patient outcomes for the better, says Dr Pienaar. “Usually, surgeons would see the patients after a diagnosis and then decide on surgery. Afterwards, I would see the patient and decide about chemo and radiation. After that, a reconstructive surgeon may be involved. With a multidisciplinary method, we all look at each case together, and decide on a treatment pathway in collaboration with other specialists.”
The main benefit of this approach, she says, is its efficiency. “It’s a lot more accurate this way. We can decide on the sequence of treatment upfront.”
Another benefit is the effect it has on emotional wellbeing. “Cancer patients have so much to deal with: chemo, body changes, fertility, the fear of death … the sooner we can normalise the patient’s emotional landscape, the better.”
For Anneke, this was the perfect environment for not only getting through the ravages of chemotherapy, but adopting a healthier, happier new life in the aftermath. “Chemo conjures up some pretty dark, negative imagery in the mind: I had this vision in my mind, of sitting in a dark room with tubes in my mouth, nauseous and vomiting. But from the moment I walked into Cancercare I felt supported.”
Anneke says her cancer treatment has taught her the value of balance. “I’ve always done everything in extremes. Going through this process has helped me implement a stress-free approach to everything in my life.”
This new outlook is a far cry from that day she pulled over on the side of the road, in shock. “When you first hear the news, cancer is a devastating diagnosis,” she says, “but over time, it can also be a chance for you to reflect on your life, and change it.”
“BREAST CANCER WAS AN OPPORTUNITY FOR ME. I’VE CHANGED MY CAREER, MY LIFESTYLE. I’VE REMOVED THE THINGS THAT ARE NOT IMPORTANT IN MY LIFE ANYMORE. I THINK I’M A BETTER PERSON NOW.”
Breast Cancer: Are you at risk?
▶ Women are much more likely than men are to develop breast cancer.
▶ Your risk of breast cancer increases as you age.
▶ If you’ve had breast cancer in one breast, you have an increased risk of developing cancer in the other breast.
▶ If your mother, sister or daughter was diagnosed with breast cancer, particularly at a young age, your risk of breast cancer is increased. Still, the majority of people diagnosed with breast cancer have no family history of the disease.
▶ If you received radiation treatments to your chest as a child or young adult, your risk of breast cancer is increased.
▶ Being obese increases your risk of breast cancer.
▶ Beginning your period before age 12 increases your risk of breast cancer.
▶ If you began menopause at an older age, you’re more likely to develop breast cancer.
▶ Women who give birth to their rst child after age 30 may have an increased risk of breast cancer.
▶ Drinking alcohol increases the risk of breast cancer.
Signs and Symptoms of Breast Cancer
▶ A breast lump or thickening that feels di erent from the surrounding tissue
▶ Change in the size, shape or appearance of a breast
▶ Changes to the skin over the breast, such as dimpling
▶ A newly inverted nipple
▶ Peeling, scaling, crusting or flaking of the pigmented area of skin surrounding the nipple or breast skin
▶ Redness or pitting of the skin over your breast, like the skin of an orange